{"id":2890,"date":"2020-03-12T12:07:53","date_gmt":"2020-03-12T12:07:53","guid":{"rendered":"http:\/\/uraloguzloc.com\/?page_id=2890"},"modified":"2021-06-28T12:30:14","modified_gmt":"2021-06-28T12:30:14","slug":"bobrek-tumorleri","status":"publish","type":"page","link":"https:\/\/uraloguz.com\/en_US\/bobrek-tumorleri\/","title":{"rendered":"Kindey Cancer"},"content":{"rendered":"[vc_row][vc_column][vc_column_text]\r\n\r\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]What is kidney cancer and how does it occur?<\/strong>\r\n\r\nKidney cancer is malignant cell growth within the kidney. Tumors in the kidney can also be benign. Cancer is the name given to malignant tumors. There are different tumor types with different stages in the kidney.\r\n\r\nWhat are the risk factors for kidney cancer? Does genetics play a role?<\/strong>\r\n\r\nAlthough it is not always possible to determine the cause of kidney cancer, smoking and obesity are reported as major risk factors.\r\n\r\nThose with kidney cancer in a first-degree relative and those with high blood pressure (hypertension) are at risk for developing kidney cancer.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016875387{margin-top: -140px !important;}”][vc_column][vc_single_image image=”2898″ img_size=”full”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016885686{margin-top: -140px !important;}”][vc_column][vc_column_text]How is kidney cancer diagnosed?<\/strong>\r\n\r\nKidney cancers constitute about 2% of all cancers. Although the number of kidney cancer patients has increased slightly in recent years, cancer-related mortality rates have decreased in many countries. Kidney cancers are often asymptomatic, meaning there are no specific symptoms that indicate the disease. Most kidney tumors are detected incidentally during routine imaging procedures. However, one in 10 patients may have symptoms such as flank pain and blood in the urine. Sometimes, although rare, conditions called paraneoplastic syndrome can be seen. These are reactions caused by any type of cancer that occurs in the body, such as high blood pressure, weight loss, fever, anemia, loss of muscle mass and loss of appetite. Kidney cancer-associated syndromes often involve liver enzymes and platelet changes. Bone pain or persistent cough may be a sign of cancer metastasis.\r\n\r\nIt is observed that the rates of early diagnosis have increased due to the advances in imaging technologies such as ultrasound and Computed Tomography (CT) \/ Magnetic Resonance Imaging (MRI) and frequent use of imaging methods for various reasons. Solid masses in the kidney should be considered malignant (malignant, malignant) unless proven otherwise. The definitive diagnosis and typing of the mass is made by biopsy or pathological examination of the mass removed by surgery.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016896834{margin-top: -140px !important;}”][vc_column][vc_column_text]What are the types of kidney cancer?<\/strong>\r\n\r\nRenal cell carcinoma (RCC) is the most common type of kidney cancer. There are\u00a0 3 subtypes of the RCC:\r\n
    \r\n \t
  1. Clear cell RCC: It is the most common and the most aggressive. It is often accompanied by the von Hippel-Lindau (VHL) gene mutation on the 3rd chromosome. Apart from this, it is known that SETD2, BAP 1 and PBRM1 tumor suppressor genes, which are located in the vicinity of the VHL gene, are also affected in clear cell RCCs.<\/li>\r\n \t
  2. Papillary RCC: It is the second most common subtype. Unlike clear cell RCC, papillary RCC is associated with MET gene mutation. They tend to be more organ-confined compared to clear cell Cancer and often exhibit exophytic growth (outgrowth from the kidney).<\/li>\r\n \t
  3. Chromophobe BHK: they are unencapsulated masses. Fuhrman grading is not allowed. Its prognosis is better than the other two.<\/li>\r\n<\/ol>\r\n \r\n\r\nBenign tumors:<\/strong>\r\n\r\nSome tumors in the kidney are not cancer. These are known as benign kidney tumors. The most common benign tumors of the kidney are oncocytoma and angiomyplipoma. The most common treatment approach for these tumors is partial nephrectomy and active surveillance.\r\n\r\nKidney cysts:\r\n\r\nThey are the most common benign lesions in the kidney. These fluid-filled sacs are located on the kidney and are easily recognized by CT. Cysts can be malignant. In this case, they must be surgically removed.\r\n\r\nThey are classified from 1 to 4 according to the Bosniak classification. Half of Bosnic type 3 cysts and 90% of Bosniac type 4 cysts are malignant.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016908613{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]What are the prognostic factors?<\/strong>\r\n\r\nAnatomical factors: Large tumor size, venous invasion, invasion of the renal capsule, invasion of the adrenal glands, lymph nodes and spread to distant organs are poor prognostic factors.\r\n\r\nHistological Factors: Fuhrman grade, subtype, sarcomatoid structure of the tumor, microvascular invasion, presence of necrosis in the tumor and collecting system invasion are important in prognosis.\r\n\r\nClinical factors: general performance of the patient, presence of local symptoms, extreme weakness, anemia, the amount of blood clot cells called platelets, the ratio of neutrophil \/ lymphocyte cells in the blood, C-reactive protein (CRP) and albumin levels in the blood are important indicators of prognosis.\r\n\r\nMolecular factors: BAP1 and PBRM1 gene loss on the 3p chromosome is seen in 90% of clear cell kidney tumors with the worst prognosis and is an important risk factor for tumor recurrence. The prognosis was reported to be worse in those with specific BAP1 mutations.[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2897″ img_size=”full” css=”.vc_custom_1584016262731{margin-left: 20px !important;}”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016918675{margin-top: -140px !important;}”][vc_column][vc_column_text]Kidney tumor biopsy<\/strong>\r\n\r\nNeedle biopsy with ultrasound or computed tomography can be performed in kidney tumors, but it is not a standard procedure used in diagnosis.\r\n\r\nA biopsy is required if:\r\n\r\n– Your scan results are not clear enough\r\n\r\n– You have a tumor small enough to be treated with active surveillance\r\n\r\n– You have a tumor small enough to be treated with radiofrequency ablation or cryoablation[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016939637{margin-top: -140px !important;}”][vc_column][vc_column_text]How is kidney cancer staged?<\/strong>\r\n\r\nKidney cancer has different stages. If the tumor is limited to the kidney and has not spread, it is called localized kidney cancer. In locally advanced kidney cancer, the tumor has grown out of the kidney into the surrounding tissue and extended to the veins, adrenal gland and lymph nodes. Metastatic disease is mentioned if it has spread to distant lymph nodes or other organs.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016950176{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]T-1: Tumors <7 cm limited to the kidney\r\n\r\nT1a: Tumor smaller than 4 cm limited in the kidney (not exceeding the kidney capsule)\r\n\r\nT1b: Tumor limited to the kidney (not exceeding the kidney capsule) with a size of 4-7 cm\r\n\r\nT-2: Kidney limited masses> 7 cm\r\n\r\nT2a: Tumor limited to the kidney (not exceeding the kidney capsule), larger than 7 cm but smaller than 10 cm\r\n\r\nT2b: Tumor diameter greater than 10 cm and not exceeding the kidney capsule\r\n\r\nT-3: Locally advanced tumors\r\n\r\nT3a: Tumor that has spread to the renal vein or its branches; or tumor extending into perirenal adipose tissue but not exceeding gerota\r\n\r\nT3b: Vena cava inferior involvement below the level of the diaphragm\r\n\r\nT3c: Vena cava inferior involvement above the level of the diaphragm, or tumor invasion of the vena cava Wall\r\n\r\nT-4: The tumor has exceeded the membrane surrounding the adipose tissue (Gerota fascia) around the kidney.\r\n\r\nLymph Nodes:\r\n\r\nNx:\u00a0\u00a0\u00a0 Regional lymph nodes not evaluated\r\n\r\nN0:\u00a0\u00a0\u00a0 No tumor spread in regional lymph nodes\r\n\r\nN1:\u00a0\u00a0\u00a0 There is tumor spread in regional lymph nodes.\r\n\r\nDistant Metastasis:\r\n\r\nM0:\u00a0\u00a0\u00a0\u00a0 Cancer does not spread to distant organs\r\n\r\nM1:\u00a0\u00a0\u00a0 Cancer has spread to distant organs.[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2893″ img_size=”full” css=”.vc_custom_1584016514788{margin-bottom: 50px !important;}”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016971676{margin-top: -180px !important;}”][vc_column][vc_column_text]What is locally advanced kidney cancer?<\/strong>\r\n\r\nIt means that the tumor has spread to the blood vessels, fatty tissue, organs and lymph nodes around the kidney. It can be called stage III or IV and shows how far the tumor has spread.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016987426{margin-top: -140px !important;}”][vc_column width=”1\/3″][vc_single_image image=”2896″ img_size=”full”][\/vc_column][vc_column width=”2\/3″][vc_column_text]How is support and treatment in kidney cancer?<\/strong>\r\n\r\nSurgical approach is the most appropriate to cure localized kidney cancers. Partial nephrectomy (removal of the tumor area by preserving the kidney) should be performed in tumors of suitable size and location. In T2 (> 7 cm) tumors or in patients whose localization is not suitable for partial nephrectomy, radical nephrectomy (removal of the kidney and surrounding tissues) is performed. Radical \/ Partial nephrectomy can be done by laparoscopic or open methods.\r\n\r\nIn locally advanced kidney cancers, it is recommended to remove the lymph nodes if lymph node involvement is detected. In vena cava thrombi, the thrombus should be removed together with the tumor kidney.\r\n\r\nIf surgery is impossible or has high risk for patient, embolization (the feeding of cancer cells is disrupted by closing the arteries leading to the tumor) may be recommended.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017000261{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]Active surveillance may be recommended especially in elderly patients in the presence of small kidney tumors (<4 cm). Studies have shown that when small masses are monitored, the tumor metastasizes in only 1% of patients. During the active surveillance period, the tumor is monitored with regular imaging procedures. If the tumor continues to grow, additional treatment may be required. In this case, ablation (radiofrequency- or cryo-) therapy may be a good alternative.\r\n\r\nAblation therapy can be performed by radiofrequency ablation (RFA) or cryotherapy. With these processes, it is aimed to kill tumor cells by heating (RFA) or freezing (cryotherapy).\r\n\r\nCancer diagnosis has a serious impact on the lives of patients and their relatives. It can lead to anxiety, fear and depression; It can affect your work and social life. When patients need support, they should share this with their doctor.\r\n\r\n[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2894″ img_size=”full”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017010632{margin-top: -140px !important;}”][vc_column][vc_column_text]Help with daily activities may be needed during the first day or weeks after surgery. Patient attendant may be important in the first days after surgery.\r\n\r\nThe follow-up protocol should be planned according to the pathology and stage in the postoperative controls.\r\n\r\nIt is important to continue your lifestyle during and after treatment. Try to eat a balanced diet consisting of vegetables, fruits and milk. Try to quit smoking. It can help you recover faster after surgery.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017033493{margin-top: -150px !important;}”][vc_column][vc_column_text]Is there any risk of the treatment?<\/strong>\r\n\r\nRadical nephrectomy is a common procedure in the treatment of locally advanced kidney cancer. Since the patient is left with a single kidney after surgery, the risk of chronic kidney failure increases, especially in patients with additional diseases such as diabetes (diabetes) and hypertension. In addition, possible decreased kidney function after surgery poses a risk for cardiovascular diseases.\r\n\r\nAs in all major surgeries, it also contains general risks of anesthesia.\r\n\r\nHow should the follow-up be and what should be considered?<\/strong>\r\n\r\nA follow-up protocol should be established according to the clinical and pathological stage after surgery. It is also very important to protect health during and after treatment, and regular physical exercise for the purpose and quitting smoking if used will reduce the risk of tumor development.\r\n\r\nIt is recommended to eat a balanced diet that includes vegetables, fruits and dairy products. Starchy meals such as bread, potatoes, rice and pasta and protein-rich foods such as meat, fish and eggs should be consumed. However, sugary, salty and fatty meals should be avoided as much as possible.\r\n\r\nAfter treatment, the prognosis of the disease may cause concern. We often see the fear of cancer recurrence in patients. If this situation creates anxiety and fear in you, you may need psychological support.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017045918{margin-top: -150px !important;}”][vc_column][vc_single_image image=”2901″ img_size=”full” alignment=”center”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017056565{margin-top: -200px !important;}”][vc_column][vc_column_text]Palliative care for kidney cancer<\/strong>\r\n\r\nPalliative care is a care that aims to improve the quality of your life when there is a disease that cannot be cured and can be done at home or in a hospital.\r\n\r\nWe also encounter situations where it is not possible to recover from kidney cancer. When the applied treatment is not successful for a longer time, palliative care is recommended to increase patient comfort.\r\n\r\nMetastatic Kidney Cancer<\/strong>\r\n\r\nKidney tumors can spread to other organs or lymph nodes. This is called metastatic disease. Kidney tumor is called primary tumor and tumors in other organs are called metastases. Kidney cancer metastasis usually spreads to the lungs, bones, distant lymph nodes, or brain. Metastatic disease may be asymptomatic or cause different symptoms depending on where the cancer has spread. In lung metastases, there may often be a persistent chronic cough or bone pain in the case of bone metastasis.\r\n\r\nIn the treatment of metastatic disease, he may recommend a combination of antiangiogenic therapy, known as target therapy, with surgery. In rare cases, immunotherapy can be used.\r\n\r\nRisk stratification in Metastatic Kidney Cancer<\/strong>\r\n\r\nMSKCC (Memorial Sloan Kettering Cancer Center) prognostic system is used to create risk classes. This classification is determined by the patient’s performance status (Karnofsky performance status <80), time between diagnosis and treatment (<12 months), blood lactate dehydrogenase (LDH) and blood calcium levels (> 10 mg \/ dl), blood hemoglobin (anemia) and neutrophil levels. Patients are divided into good, moderate and poor prognostic risk classes.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017182368{margin-top: -140px !important;}”][vc_column width=”1\/3″][vc_single_image image=”2895″ img_size=”full” alignment=”right” css=”.vc_custom_1584017169390{margin-right: 10px !important;}”][\/vc_column][vc_column width=”2\/3″][vc_column_text]Treatment Options in Metastatic Kidney Cancer<\/strong>\r\n\r\nIf there is metastatic disease, surgical removal of the kidney (cytoreductive nephrectomy) is recommended to reduce tumor burden and alleviate symptoms. The results of the CARMENA study showed that while cytoreductive nephrectomy prolongs survival significantly in patients in the good-risk group, it does not benefit survival in patients in the moderate and poor-risk groups.\r\n\r\nIf the metastasis causes too much pain or other symptoms, additional surgery may be required to remove these metastatic tumors. Cytoreductive partial nephrectomy can be performed in patients with a single kidney or where the primary tumor is not too large and the other kidney is not working. In metastatic disease, surgery is combined with medication.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017233344{margin-top: -150px !important;}”][vc_column][vc_column_text]Radiotherapy may also be recommended for the treatment of metastasis. However, kidney tumors generally do not respond to radiotherapy. Therefore, it can only be recommended to relieve symptoms caused by a primary tumor or metastasis that cannot be surgically removed. Despite all these, the role of stereotactic body radiotherapy, which can be given in several fractions, by using high doses per fraction in oligometastatic disease or in the treatment of primary tumor, and radiotherapy in renal cell carcinoma have gained importance.\r\n\r\nUsually, metastatic disease cannot be cured. Treatment of metastatic disease is aimed at reducing the size of the primary tumor and metastases. This will give the patient the chance of a longer life and less symptoms. These are general information and treatment differences may occur for each patient.\r\n\r\nChemotherapy is also not a very effective treatment option for kidney cancer. Combined immunotherapy with 5-fluorouracil may be effective after complete resection (complete removal) of the primary tumor in metastatic tumors.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017277215{margin-top: -150px !important;}”][vc_column][vc_column_text]Immunotherapy is one of the drug treatments used in metastatic kidney cancers. Immunotherapy is a type of treatment that strengthens the immune system to combat tumor cells. 2 different immunotherapy can be used in metastatic kidney tumors.\r\n\r\n– Interferon-alpha (INF-\u03b1)\r\n\r\n– Interlokin-2 (IL-2)\r\n\r\nAntiangiogenic treatments are the most commonly used drug treatments in metastatic kidney cancers.\r\n\r\nThe patient may be recommended preoperative drug therapy to shrink the tumor. In some cases, antiangiogenic therapy is used before surgery to see how the cancer will respond to this. If a good response is obtained, treatment is continued after surgery. If surgical treatment is not possible, drug treatments are started. Generally, antiangiogenic therapy, which acts on tumor growth by preventing the formation of blood vessels, is preferred.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017516094{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]Antiangiogenic Therapy<\/strong>\r\n\r\nThese treatments are arranged and applied by a medical oncologist. However, treatment and follow-up with a multidisciplinary approach is very important in kidney cancers.\r\n\r\nAntiangiogenic (tyrosine kinase inhibitors and monoclonal antibodies) drugs commonly used in kidney cancer treatment:\r\n\r\n-Sunitinib -Pazopanib -Axitinib -Sorafenib -Tivozanib -Bevacizumab[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2906″ img_size=”full”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017504577{margin-top: -140px !important;}”][vc_column][vc_column_text]mTOR inhibitor drugs aim to shrink the tumor by attacking the enzyme. mTOR is a serine \/ threonine kinase from the TOR (target of rapamycin) protein family. With mTOR inhibition, both mRNA translation of proteins that work in the cell cycle decreases and HIF-1\u03b1 translation decreases. There are 2 agents that inhibit this pathway:\r\n\r\n-Temsorulimus -Everolimus\r\n\r\n \r\n\r\nFatigue and nausea are common side effects during these treatments. There may also be diarrhea and constipation. You may have high blood pressure during treatment. While taking these medications, you may experience shortness of breath, chest pain, and swollen ankles and feet. It can also cause clot formation, increasing the risk of heart attack and stroke. You may have dryness, redness or a rash on your skin. In some cases, the skin may turn yellow and improve after treatment is over. You may experience numbness and tingling in the fingers and toes. During the treatment, your hair may turn gray. Some colors may come back between treatment sessions. Blisters and rashes on the palms and soles (hand foot syndrome) may develop or a bitter taste sensation may occur in the mouth.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]\r\n\r\n[\/vc_column_text][\/vc_column][\/vc_row]","protected":false},"excerpt":{"rendered":"

    [vc_row][vc_column][vc_column_text]<\/p>\n

    [\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text]What is kidney cancer and how does it occur?<\/strong><\/p>\n

    Kidney cancer is malignant cell growth within the ki…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-2890","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/pages\/2890","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/comments?post=2890"}],"version-history":[{"count":20,"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/pages\/2890\/revisions"}],"predecessor-version":[{"id":3311,"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/pages\/2890\/revisions\/3311"}],"wp:attachment":[{"href":"https:\/\/uraloguz.com\/en_US\/wp-json\/wp\/v2\/media?parent=2890"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}